Inside a lab in Pisa, forensics pathologist Gino Fornaciari and his team investigate 500-year-old cold cases

King Ferrante II, who died young and surpassingly handsome at 28, shortly after the great Carpaccio painted his portrait, was found to have head lice, as well as poisoning from the mercury he used in an attempt to vanquish the infestation. An anonymous, richly dressed member of the Aragon family, about 27 years of age, had a fatal dagger wound in his left side, between the eighth and ninth ribs, with signs of massive bleeding.

Fornaciari also studied electron micrographs of tissue samples from an anonymous 2-year-old Aragonese child who died around 1570. He observed the lethal smallpox virus—which reacted to smallpox antibodies after centuries in the grave. Concerned that the virus could still be infectious, the Italian Ministry of Health threatened to close Fornaciari’s lab and impound the tiny cadaver, until Fornaciari reported that he had already sent samples for testing to the United States and Russia, where specialists pronounced the smallpox DNA biologically inert and therefore harmless.

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Fornaciari uncovered some of his most moving and detailed personal stories during exhumations of the Medici, begun in 2003. A driving force in the artistic, intellectual and economic life of the Italian Renaissance, the noble house helped to establish Florence as the cultural center of the Western world. The Medici were the patrons of Brunelleschi, Leonardo da Vinci, Michelangelo, Botticelli and Galileo Galilei. “You can’t really remain indifferent to someone like Cosimo I de’ Medici, one of the architects of the Renaissance,” Fornaciari says. An inexperienced teenager who suddenly came to power in Florence in 1537, Cosimo rescued the city-state of Florence, turning a foundering republic at the mercy of foreign powers into an independent duchy that was once more a major player on the European stage. He founded the Uffizi Gallery, freed Florentine territories from foreign armies and built a navy, which was instrumental in preventing the Ottoman takeover of the Mediterranean Sea during the Battle of Lepanto in 1571.

The wealth of biographical information available on Cosimo I allowed Fornaciari to synthesize contemporary testimony and forensic investigation. Documentation concerning Cosimo and his descendants is some of the most extensive in early modern history—the online database of the Medici Archive Project contains descriptions of some 10,000 letters and biographical records on more than 11,000 individuals. Portraits of Cosimo I in museums around the world depict his evolution from a shy, seemingly wary youth in 1538 to a bearded warrior in a polished suit of armor in 1565, and an elderly, corpulent and world-weary figure, gazing absently into space, toward the end of his life in 1574. Reports by court physicians and foreign ambassadors to the Florentine duchy recount Cosimo’s medical history in excruciating detail: He survived smallpox and “catarrhal fever” (likely pneumonia) in youth; suffered in later life from paralysis of his left arm, mental instability and incontinence; and had a painful condition of the joints described by contemporaries as gout.

Fornaciari found that Cosimo’s remains indicated he had been an extremely robust and active man, in whom Fornaciari also noted all of the “knightly markers”—sacro-lumbar arthritis, hypertrophy and erosion of certain parts of the femur, rotation and compression of the upper femur, and other deformations—typical of warriors who rode into battle on horseback. He noted nodes between Cosimo’s vertebrae, signs that as an adolescent, the young duke had worn heavy weights over his thorax, most probably suits of armor. Fornaciari also noticed pervasive arthritis and ossification between the sixth, seventh and eighth thoracic vertebrae, possible signs of diffuse idiopathic skeletal hyperostosis (DISH), a disease of the elderly linked to diabetes. “We see Cosimo getting fatter in his portraits, and the presence of DISH suggests he may have had diabetes, too,” says Fornaciari. “The diet of the Medici and other upper-class families often contained many sweets, which were a sort of status symbol, but often caused health problems.”

Another vivid marker was Cosimo’s poor dental health. The right side of his mandible is marred by an enormous gap, the result of a serious periodontal disease; an abscess had eaten away his first molar and a considerable chunk of bone, leaving a massive crater in his jaw. Fornaciari’s examination of the Medici, the Aragonese and other high-born individuals has revealed appalling abscesses, decay and tooth loss, bringing home just how painful daily life in that period could be, even for the rich and famous.

Cosimo’s wife, Eleanora of Toledo, was the daughter of the Spanish viceroy of Naples and related to the Hapsburg and the Castilian royal families. Her face was immortalized by the Renaissance master Bronzino, who in a series of portraits captures her transformation from a radiant, aloof young bride to a sickly, prematurely aged woman in her late 30s, shortly before her death at age 40. Fornaciari uncovered the maladies that beset her. Dental problems plagued her. Slightly curved legs indicated a case of rickets she had suffered as a child. Childbirth had taken a major toll. “Pelvic skeletal markers show that she had numerous births—in fact, she and Cosimo had 11 children,” Fornaciari says. “She was almost constantly pregnant, which would have leached calcium out of her body.” Further analysis indicated that Eleanora had suffered from leishmaniasis, a parasitic disease spread by biting sand flies that can cause skin lesions, fever and damage to the liver and spleen. DNA testing also revealed the presence of tuberculosis. “She was wealthy, and powerful, but her life was brutally hard,” Fornaciari says.

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Ultimately, Fornaciari also dispelled murder allegations directed against one of Cosimo and Eleanora’s sons. On September 25, 1587, Cardinal Ferdinando de’ Medici, second surviving son of Cosimo I and Eleanora of Toledo, visited his elder brother Francesco I in the opulent Medici villa in Poggio a Caiano, in the countryside near Florence. The brothers had been on bad terms for years, their relations poisoned by ambition and envy: Cardinal Ferdinando resented the fact that the coveted ancestral title, Grand Duke of Tuscany, had gone to Francesco after Cosimo’s death, and violently disliked his new sister-in-law, Bianca Cappello. Her young son Antonio, fathered by Francesco and legitimized when the couple had married, seemed likely to inherit the throne eventually. This gathering seemed a chance to mend bridges between the brothers and restore family peace.

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